Republicans plan work requirement for Medicaid – but hold off on slashing federal contributions
House Republicans released the legislative text for the Medicaid aspect of their massive domestic policy bill, which will put in place strict work requirements and risks millions of Americans losing their health care.
The House Energy and Commerce Committee released the text for their aspect of the legislation President Donald Trump has taken to calling the “one big, beautiful bill.”
The proposed legislation would delay multiple rules put in place for Medicaid – which provides health insurance for people on low incomes – during the Biden administration. In addition, it would require states to add extra steps to verify the addresses of Medicaid and Children’s Health Insurance Program (CHIP) recipients. States would also be required to increase their determinations for whether someone is eligible for Medicaid to every six months.
The legislation would also delay the implementation of the Biden administration’s rule increasing staffing standards for long-term care facilities and prohibit the use of Medicaid dollars to pay for gender-affirming care for transgender people under the age of 18.
But the biggest part of the Medicaid aspect of the legislation are the work requirements. Specifically, able-bodied adults without children or dependents would need to work at least 80 hours a month, engage in 80 hours of community service or engage in 80 hours for an educational program. They could also engage in a combination of these three options.
People younger than 19 and older than 64 years would be exempt from the work requirements, as well as pregnant women, foster youth, former foster youth up to the age of 26, people with disabilities, members of Native American tribes or people already in compliance with work requirements for the Temporary Assistance for Needy Families, formerly known as welfare, or Supplemental Nutrition Assistance Program.
Earlier this year, the House passed a budget resolution that stipulated that for Republicans to pass $4.5 trillion worth of tax cuts, they would need to find $1.5 trillion worth of spending cuts. If they fail to find $2 trillion worth of spending cuts, the amount of money for tax cuts is reduced by the difference between $2 trillion and the final number of spending cuts.
The budget resolution required that the House Energy & Commerce Committee, which governs Medicaid, find $880 billion worth of spending cuts.
Last month, the House passed the Senate’s version of the budget resolution, which does not have as many hard commitments on spending cuts.
Still, hardline conservatives want to see long-term changes to Medicaid. On Monday, Representative Chip Roy of Texas, a member of the staunchly right-wing House Freedom Caucus, blasted the legislation.
“I sure hope House & Senate leadership are coming up with a backup plan,” Roy said on X. “because I’m not here to rack up an additional $20 trillion in debt over 10 years or to subsidize healthy, able-bodied adults, corrupt blue states, and monopoly hospital ceos.”
But many Republicans in the Senate and the House do not want to push for across-the-board cuts to Medicaid, specifically in states that expanded Medicaid under the 2010 health care law signed by Barack Obama, also known as the Affordable Care Act or Obamacare.
Republicans have said that they would be open to work requirements. Last month, House Speaker Mike Johnson specifically said “29-year-old males sitting on their couches playing video games” would be sent to work instead of being allowed to collect Medicaid.
At the same time, the legislation chose not to cut federal contributions to Medicaid, which worried many Republicans who expanded Medicaid. Under the 2010 health care law, the federal government covers up to 90 percent of the cost for people up to 138 percent of the federal poverty level. Numerous states have “trigger laws” wherein state governments would roll back spending for Medicaid, according to the Kaiser Family Foundation.
